Difference In Prevalence Of Anemia Research Articles

Global Prevalence of Anemia Among Women of Reproductive Age, 2000-2019

Introduction: A common disease with significant impacts on health and quality of life, anemia is particularly prevalent in women of reproductive age due to blood losses during menstruation and pregnancy. Data from the World Health Organization (WHO) was analyzed to compare trends in prevalence of anemia in women aged 15-49 among countries and over time with the goal of identifying regions both successful and in need of assistance in combatting anemia. Methods: Publicly available data was obtained from the WHO on the prevalence of anemia among women aged 15-49 from 194 countries from 2000-2019, data being reported as percentages. Anemia was defined as hemoglobin < 12 g/dL for non-pregnant women and < 11 g/dL for pregnant women, with severe anemia being defined as hemoglobin < 8 g/dL for non-pregnant women and < 7 g/dL for pregnant women. WHO data was from both individual-level and summary statistics sources and hemoglobin was adjusted for altitude. Human development index (HDI) data and categories (low, medium, high, and very high) were obtained from the United Nations. Data was analyzed based on year, country, geographic region, and HDI, with ANOVA and Tukey HSD tests being used to analyze the relationship between HDI and anemia. Results: Worldwide from 2000 to 2013 the prevalence of anemia decreased, and then increased from 2013 to 2019 though remained lower than at 2000 levels; severe anemia decreased throughout the world from 2000 to 2019. Throughout all years, African countries had the highest prevalence of anemia and severe anemia while American and European countries had the lowest (Figure 1). When analyzed by HDI category, there was a significant difference among HDI categories with both total and severe anemia ( P < 0.001 for both). With each decrease in HDI category (very high to high, etc.) there was a significant increase in prevalence of total anemia (Table 1, P < 0.001 for all). For severe anemia, there was a significant difference in prevalence of anemia between all HDI levels except very high and high ( P = 0.09). Discussion: This data suggests that although the prevalence of anemia among reproductive age women has decreased over time there is still much work remaining, particularly in low HDI countries, where the prevalence of anemia was over twice that of very high HDI countries in 2019, and the prevalence of severe anemia was over three times as high. More research is needed into the relationship of anemia and socioeconomic status as well as preventing, recognizing and treating anemia.

Anemia prevalence time trends and disparities in the US population: examination of NHANES 1999-2020.

While a rising prevalence of anemia in the United States was reported in older studies, recent data are lacking. To estimate the prevalence and time trends of anemia in the United States and to examine how these estimates differ by gender, age, race, and household income to poverty threshold ratio (HIPR), we used the National Health and Nutrition Examination Surveys from 1999 to 2020. The presence of anemia was determined using the World Health Organization criteria. Survey-weighted raw and adjusted prevalence ratios (PRs) were determined using generalized linear models for the overall population and by gender, age, race, and HIPR. In addition, an interaction between gender and race was explored. Complete data on anemia, age, gender, and race were available on 87,554 participants (mean age = 34.6 years, women = 49.8%, Whites = 37.3%). Anemia prevalence increased from 4.03% during the 1999-2000 survey cycle to 6.49% during 2017-2020. In adjusted analyses, anemia prevalence was higher in >65 than in 26-45 years old (PR = 2.14, 95% confidence interval (CI) = 1.95, 2.35), in Blacks than Whites (PR = 3.97, 95% CI = 3.63, 4.35), in women than men (PR = 1.98, 95% CI = 1.83, 2.13), and in those with HIPR ≤ 1 than >4 (PR = 0.68, 95% CI = 0.61, 0.75). Gender modified the relationship between anemia and race; when compared to their male counterparts, Black, Hispanic, and other women had higher anemia prevalence than White women (all interaction p values <0.05). The anemia prevalence in the United States has risen from 1999 to 2020 and remains high among the elderly, minorities, and women. The difference in anemia prevalence between men and women is larger in non-Whites.

Deworming program for women of reproductive age implemented through national iron folate supplementation program reduces prevalence of anemia: evidence from a community trial in rural Bangladesh

Background: Anemia causes debilitating outcomes for women and children, and can be of multifactorial etiology, soil transmitted helminth (STH) infection being one of them. The Bangladeshi government does not have any regular deworming program for women of reproductive age (WRAs), who constitute an important portion of the population. Hence, we conducted this study to generate evidence on the effect of regular deworming on STH infection status and anemia status of WRAs in rural Bangladesh. Methods: This was a quasi-experimental study conducted in rural Bangladesh using existing healthcare delivery platform (Community Clinics) for mass deworming of WRAs. Catchment areas of two community clinics constituted the intervention arm, where the WRAs received two cycles of deworming four months apart on top of government recommended iron-folate supplementation (IFA), and catchment areas of two different community clinics were considered as the control arm where the study population received IFA but no deworming medication. Baseline and endline surveys were conducted on randomly selected participants to measure prevalence of anemia and STH infection using HemoCue 201+ and Kato-Katz respectively. Results: The study area contained 4791 women aged 15-49 years. Among them, 2441 lived in the intervention area and 2350 lived in the control area. Compliance to deworming medication and IFA was 82% (2001 out of 2441) and 79% (1938 out of 2441) for the two cycles, respectively. In the baseline survey there was no significant difference in prevalence of anemia between the intervention and control arms (63.7% vs 65.7%; p=0.522). However, the endline survey yielded significant difference in anemia prevalence between the arms (47.5% vs 65.7%, p&lt;0.001) rendering a 14% reduction in anemia due the intervention (p=0.004). Similarly, our intervention was shown to reduce STH infection by 16% (p&lt;0.001) Conclusions: Our study clearly showed that regular deworming of WRA benefits their anemia and STH infection status.

Rural and urban disparities in anemia among Peruvian children aged 6-59 months: a multivariate decomposition and spatial analysis.

Anemia is a global public health issue that affects mainly children aged less than 5 years. In Peru, despite the reduction in the prevalence of anemia between 2010 and 2018, anemia remains a major concern, especially in high-risk zones such as rural areas. Several sociodemographic factors have been associated with anemia in children; however, components contributing to the urban-rural gap have not been previously assessed. The purpose of this study was to evaluate the determinants of the difference in anemia prevalence between urban and rural areas, and its spatial distribution in Peruvian children aged 6-59 months. A secondary data analysis was conducted using the 2019 Peruvian Demographic Health Survey. The study population included 18 846 children aged 6-59 months. A multivariate decomposition analysis for non-linear response model was performed to identify the factors contributing to the gap in the prevalence of anemia across urban and rural areas. Global Moran&acute;s I autocorrelation, Ordinary Kriging interpolation and Bernoulli-based purely spatial scan statistics were employed to assess the spatial pattern of anemia. Nationwide, the prevalence of anemia in Peru was 29.47% (95%CI 28.63-30.33). In rural areas, it was 38.25%, and in urban areas 26.39%. The decomposition analysis revealed that 88.61% of the difference in the prevalence of anemia between urban and rural areas was attributed to the difference in the respondents' characteristics. Wealth index, mother&acute;s education, mother&acute;s employment status, number of living children and mother&acute;s age were key determinants contributing to the rural-urban gap. Spatial heterogeneity of anemia prevalence in childhood was observed at both inter- and intradepartmental level. The SaTScan spatial analysis identified six significant cluster areas with high prevalence of anemia in childhood. A considerable gap of anemia prevalence between urban and rural areas was found. Targeted interventions are necessary to reduce geographic disparities.

Prevalence of Anaemia among Adolescent Girls on Weekly Iron and Folic Acid Supplementation (WIFS) and Non WIFS Group in Rural Schools of Mangalore, Karnataka; a Comparative Study

Background: Weekly Iron and Folic Acid Supplementation (WIFS) Programme is an initiative to decrease the burden of anaemia among adolescents studying in Government schools.&#x0D; Objective: To assess the difference in prevalence of anaemia among Government school-going adolescents girls on WIFS as compared to private school girls not on WIFS.&#x0D; Methods: Cross-sectional study was conducted among adolescent girls, 7th to 10th standard in Government schools (on WIFS) and private schools (not on WIFS). The sample size in each group was 104, selected by multi-stage sampling. Data was collected using semi-structured questionnaire, clinical examination and haemoglobin estimation. Chi-square test and Unpaired t test used to compare the categorical and continuous variables respectively.&#x0D; Results: The prevalence of anaemia among the school children in government schools was 51% and in the private schools it was 64.4%. The mean haemoglobin was 11.77 ± 1.41 and 11.34 ± 1.49 in government and private school girls, respectively, which was statistically significant (p=0.013).&#x0D; Conclusions: The prevalence of anaemia among the government school girls was lesser as compared to the private schools girls, suggesting the role of WIFS in the reduction of prevalence of anemia. WIFS programme may be extended to private schools as well.

Prevalence of anemia among school girl children and effectiveness of supplementation intervention

Background: Iron deficiency anemia (IDA) is a major public health issue worldwide, especially in developing countries. Anemia prevalence in young children, particularly girls, continues to remain high in most parts of India and Asia. Aims and objectives were to study the prevalence of anemia (IDA) among school girl children of age group between 5-16 years and to assess the effectiveness of iron-folic acid supplements and iron rich diet.Methods: The study was conducted among 558 school girls in the age group between 5-16 years (1st to 10th standard) at a Kendriya Vidyalaya in Punjab. The study group was checked for their hemoglobin level. Health education regarding prevention of anemia was imparted to girls and their parents followed by daily iron-folic acid supplement. Their hemoglobin was again checked after three months of supplementation.Results: The prevalence of anemia in the study group was 65%. After the intervention, the Hb level was significantly increased as shown by increase in mean and SD of Hb% from 9.75±1.24 to 11.66±0.98. The data was analyzed in two age groups, 5-10 years and 11-16 years, to check for any significant variation in their Hb levels. Though there was difference in prevalence of anemia in these age groups, the difference was not statistically significant.Conclusions: The study showed that prevalence of anemia is 65% and is still one of the major public health issues among school going girl children of all age. In addition to pre-school and adolescent girls, we also need to focus on pre-puberty girls, as anemia is equally prevalent among them.

Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

BackgroundIn patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. MethodsWe studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. ResultsThe median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). ConclusionsApproximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention.

High Prevalence of Anemia among Human Immunodeficiency Virus-Infected Patients: A Cross-sectional Study in Bali-Indonesia

Anemia is a common condition found among Human Immunodeficiency Virus (HIV)-infected patients. T-cells that are infected with HIV virus can directly suppress the growth of progenitor cells in the bone marrow so that affecting the hemopoiesis resulted in anemia. These hematological abnormalities could potentially cause serious clinical implications. This study was conducted to determine the prevalence of anemia in HIV-infected patients in Bali. It was ahospital based cross-sectional studyconducted at two public hospital in Bali-Indonesia. A total of 243 medical record data from HIV-infected patients atWangaya Hospital Denpasar Bali and Sanjiwani Hospital Gianyar Bali between 2009 -2017 were included in analysis. Prevalence of anemia in antiretroviral (ART)-naïve patients and in patients on ART were 60.8% and 40.3%, respectively. Leucopenia and thrombocytopenia were found 8.2% and 9.4%, respectively, in ART-naïve group. While in patients with ART group leucopenia and thrombocytopenia were accounted for 6.9% and 4.3%, respectively. There was a significant difference in prevalence of anemia between ART-naïve patients and patients on ART (60.8% vs. 40.3%; p &lt; 0.05). Although the prevalence of anemia was lower in patients on ART, but anemia continues to be common in a substantial portion of HIV-infected persons. Another studies are still needed to addressing the impact of anemia on HIV-infected individuals, as well as treatment strategies and future research directions.

Magnitude of Anemia and Socio Demographic Factors Associated With It Among Adults Age 15-49 Years In Ethiopia: A Population Based Study Using The 2016 Demographic and Health Survey Data

Background: According to World Health Organization (WHO); anemia considered as a major public threat when prevalence was greater than 40%, a moderate public threat from 20-40%, and as a mild threat from 5-20%. This study aims to assess the prevalence of anemia and its associated socio demographic factors among adults age 15-49 years in Ethiopia. Methods: Demographic and Health Surveys in 2016, in Ethiopia were analyzed in SPSS, using multivariate logistic regression. Socio demographic variables were selected based on their availability in the dataset. Results: Of the total sample of 27289 of men and women 15-49 years at the time of survey, 19.8 % (n = 5078) anemia. Men and women 15-49 years living in rural areas 0.029 (AOR 0.029 ; 95% CI:0.018-0.048) ,men and women age living in afar region 0.821 (AOR 0.821; 95% CI: 0.725--0.929) , men and women who are in lowest wealth quintile 1.255 (AOR 1.255; 95% CI: 1.091-1.445) and an increase in one-year in age 9.952 (95% CI 6.2 to 16.1) were found significant predictors of anemia. Conclusions: The magnitude of anemia in the current study was found to be a mild public health problem. Rural residence, low wealth quartile and old age were predictors of anemia among adults Age 15-49 years. There is significant urban-rural difference in anemia prevalence, indicating the need for targeting specific areas for intervention.

Groundwater iron has the ground: Low prevalence of anemia and iron deficiency anemia in Bangladesh

Dear Editor: Stewart et al. (1) presented a robust trial assessing the effects of water, sanitation, and hygiene (WASH) and nutrition-specific interventions (lipid-based nutrient supplements and infant and young child feeding) on anemia and micronutrient status among children in Kenya and Bangladesh. The trial found a lower prevalence of anemia and iron deficiency anemia in Bangladesh than in Kenya. The authors suggested that their results in the Bangladesh site differed from the Bangladesh national micronutrient survey 2011–2012 because the 2011 survey used capillary sampling, whereas they used venous blood sampling. This was not the case; the 2011 survey used venous blood to measure hemoglobin (2). Alternatively, the difference in anemia prevalence seen between the 2 studies might be that one was a national survey, and the other was conducted in a localized setting.

Prevalence of anemia among women of reproductive age in Republic of Srpska

&amp;lt;p&amp;gt;Introduction. Anemia is an important public health problem recognized worldwide either as an isolated problem or associated with other forms of malnutrition. In 2016, the prevalence of anemia in women of reproductive age was 32.0%, that is 613 millions of women, aged 15-49 years. The aim of the present study was to determine the prevalence of anemia among women of reproductive age (&amp;amp;gt;15&amp;amp;le;49 years) in the Republic of Srpska as well as to determine the correlation between dietary habits and prevalence of anemia. Methods. The study was conducted as a cross-sectional study. The sample was designed as a two-stage stratified random sample, with census circles selected during the first stage and households in the second stage. The study included 1539 women, aged 15-49 years. For the assessment of dietary habits and basic socio-demographic characteristics of the sample, two specially created questionnaires were used. Photometer, HemoCue Hb 301/SET was used to determine the hemoglobin level from a capillary sample. Results. The prevalence of anemia among women in reproductive age in the Republic of Srpska was 11.8%, classifying the Republic of Srpska into countries with low prevalence. There was a statistically significant difference in prevalence of anemia among women (p&amp;amp;lt; 0.001), aged 36-49 years, and within Doboj and East Sarajevo Region (p = 0.002). Analyzing dietary habits, with special emphasis on intake of heme and non-heme iron foods, a statistically significant difference was found in intake of heme iron foods (p=0.009) among the women without anemia. There was a weak but statistically significant correlation between intake of iron supplement and absence of anemia (r = -0.064, p = 0.013). Conclusion. The Republic of Srpska falls into the category of countries with low anemia prevalence but it is necessary to continue with the activities the aim of which should be dietary habit improvement among all population groups, with the special emphasis on intake of heme iron foods.&amp;lt;/p&amp;gt;

Deworming in non-pregnant adolescent girls and adult women: a systematic review and meta-analysis

BackgroundThe impact of deworming on parasite load, nutritional status and other health outcomes of non-pregnant adolescent girls and adult women is uncertain.MethodsMEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the WHO International Clinical Trials Registry Platform, the Cochrane Database of Systematic Reviews and Food and Technology s databases were searched until 24 September 2018. Studies were included if they were randomised controlled trials (RCTs), controlled before and after studies or interrupted time studies comparing deworming with no intervention or placebo in non-pregnant adolescent girls and women 10 to 49 years old. Outcomes of interest included parasite load, reinfection, anaemia, severe anaemia, iron deficiency, diarrhoea or all-cause morbidity. Risk of bias was assessed using the Cochrane risk of bias tool.ResultsWe included four RCTs of mass deworming involving 1086 participants, in the analyses. Mass deworming probably reduces the prevalence of roundworm infection (RR 0.29; 95% CI 0.14 to 0.62; 2 trials; 1498 participants, moderate certainty evidence), prevalence of hookworm infection (RR 0.32; 95% CI 0.18 to 0.59; 2 trials; 1498 participants, moderate certainty evidence), prevalence of whipworm infection (RR 0.77; 95% CI 0.65 to 0.91; 2 trials; 1498 participants, moderate certainty evidence) compared to the control group. Deworming may make little or no difference in prevalence of anaemia (RR 0.82; 95% CI 0.60 to 1.11, 3 studies, 683 participants, low certainty evidence) and prevalence of iron-deficiency (RR 0.89; 95% CI 0.64 to 1.23, 1 study, 186 participants, low certainty evidence) compared to control. We are uncertain whether deworming reduces the prevalence of severe anaemia compared to control as the certainty of evidence was very low. None of the included studies assessed screen and treat deworming or reported reinfection, diarrhoea or adverse events.ConclusionsMass deworming probably reduces the prevalence of soil-transmitted helminth infections but may have little or no effect on anaemia and iron-deficiency in adolescent girls and non-pregnant women in comparison to no intervention or placebo. We are uncertain about the effect on severe anaemia. These results are limited by sparse data and the moderate to very low quality of evidence available.Systematic review registrationThe protocol was registered in PROSPERO (registration number: CRD42016039557). Primary source of funding: Evidence and Programme Guidance unit, Department of Nutrition for Health and Development, World Health Organization (WHO).

Relationship between cobalamin and folate deficiencies and anemia in dogs.

BackgroundMegaloblastic, nonregenerative anemia is a well‐known consequence of cobalamin or folate deficiencies in humans but is not recognized in hypocobalaminemic or hypofolatemic dogs. Establishment of relationships between hypocobalaminemia or hypofolatemia and hematologic disease would encourage vitamin B testing, and potentially supplementation, in anemic dogs.ObjectivesTo determine the prevalence of anemia in hypocobalaminemic or hypofolatemic dogs and to report the prevalence of hypocobalaminemia and hypofolatemia and nonregenerative anemia, macrocytosis, and anisocytosis in anemic dogs.AnimalsOne hundred and fourteen client‐owned dogs with known serum cobalamin and folate concentrations and CBCs and 42 client‐owned anemic dogs.MethodsRetrospective comparison of anemia prevalence in hypocobalaminemic or hypofolatemic and normocobalaminemic or normofolatemic dogs was performed. Prospective measurement of erythrocyte variables and cobalamin and folate concentrations in anemic dogs was carried out; relationships among hypocobalaminemia and regenerative status, mean corpuscular volume, and red cell distribution width were evaluated.ResultsSignificant differences in prevalence of anemia between hypocobalaminemic (36%) and normocobalaminemic dogs (26%; P = .23) or between hypofolatemic (31%) and normofolatemic dogs (30%; P = .99) were not detected. Between hypocobalaminemic and normocobalaminemic dogs, no significant differences in prevalence of nonregenerative anemia (69% vs 63%; P = .65), macrocytosis (17% vs 0%; P = .53), or anisocytosis (28% vs 0%; P = .14) were detected. Anemic dogs had high prevalence of vitamin B deficiencies (nonregenerative: 64% hypocobalaminemic, 18% hypofolatemic; regenerative: 57% hypocobalaminemic, 21% hypofolatemic).Conclusions and Clinical ImportanceThe association between cobalamin and folate deficiencies and macrocytic, nonregenerative anemia established in humans is not routinely present in dogs.

Prevalence of Anaemia among the Elderly in Malaysia and Its Associated Factors: Does Ethnicity Matter?

Introduction Anaemia is common among the elderly, yet it remains an underresearched clinical condition. This study investigates ethnic differences in prevalence of anaemia and identifies potential factors associated with anaemia in the elderly. Methods Data from the National Health & Morbidity Survey (NHMS) 2015 conducted by Ministry of Health was analyzed. Haemoglobin levels were measured using point-of-care testing, HemoCue® Hb 201+ System©, from consenting individuals. Demographic information and other clinical information were obtained through a structured questionnaire. Descriptive and multivariate analyses were conducted and significant results were presented as adjusted odds ratio. Results A total of 3794 participants aged 60 years and older responded to the anaemia module with a response rate of 93.7%. 64.0% of respondents were of Malay ethnicity, 21.6% were Chinese, 6.1% were Indians, and 8.3% were of other ethnicities. The overall prevalence of anaemia among older people was 35.3%. The highest prevalence of anaemia was found among respondents of Indian ethnicity (45.5%). The Indian (aOR: 1.72; 95% CI 1.26–2.34) and Malay (aOR: 1.25; 95% CI 1.04–1.49) ethnic groups were more likely to be anaemic in comparison to those of Chinese ethnicity. Anaemia in older people was also associated with increasing age, history of hospital admission, and the presence of diabetes mellitus. Conclusion Anaemia in the elderly is associated with Indian and Malay ethnicities, increasing age, hospitalization, and diabetes. Our study has identified important information on a common condition which will guide and assist future studies in reducing the burden of anaemia.

The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial.

Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010–2013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether–lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (N = 8,766), and a cohort of children was followed for approximately 18 months (N = 992). The primary outcome was prevalence of anemia (hemoglobin < 11.0 g/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91–1.13; P = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains.

A study of anemia in human immunodeficiency virus patients: Estimating the prevalence, analyzing the causative effect of nutritional deficiencies, and correlating the degree of severity with CD4 cell counts

Background: Anemia is a common complication of human immunodeficiency virus (HIV) infection. The role of iron, Vitamin B12, and folate deficiencies, which are otherwise most common causes of anemia, is not well-established in HIV patients. Several studies in India have shown that severe immunodeficiency is associated with higher grade of anemia, but correlation of CD4 cell counts with severity of anemia is not well-documented. Aims: The aims of the present study were: To estimate the point prevalence of anemia in HIV patients, to analyze the causative role of iron, Vitamin B12, and folate deficiencies in anemic HIV patients, and correlating the degree of severity of anemia with CD4 cell counts. Materials and Methods: This study was a cross-sectional study. The study group enrolled 103 consecutive HIV patients attending medical emergency, medical outpatient department, medical wards, and anti-retroviral therapy (ART) center at a tertiary care medical center in North India. Study participation consisted of a single visit during which relevant data, including medical history, current medications, CD4 T-lymphocyte count, complete hemogram with red blood cell indices, peripheral smear picture, iron studies, serum Vitamin B12, serum folate and bone marrow studies, were recorded on a case report form. Anemia was classified according to the World Health Organization criteria. Data analysis was carried out using Microsoft Excel and Statistical Package for the Social Sciences software. Results: 86.4% (89/103) patients were found to be anemic. There was no significant difference in prevalence of anemia in ART-naive patients from those who were on ART (P > 0.05). Pearson's correlation had shown a highly significant positive correlation of hemoglobin and CD4 cell counts in male patients (r = 0.418) as well as female patients (r = 0.565). Normocytic normochromic was the most common type of anemia in males (46%) as well as females (42%). Significant iron deficiency (P = 0.022) was observed in 42.85% of the patients having microcytic hypochromic anemia. Significant Vitamin B12 and folate deficiencies were observed in patients having macrocytic anemia (47.05%, P = 0.003 and 35.29%, P = 0.012, respectively). Conclusions: This study shows that anemia is highly prevalent in HIV patients and severity of anemia increases with decrease in CD4 cell counts. Nutritional deficiencies play a significant role in causing anemia in these patients.

Evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia: A method-comparison study

BackgroundGenetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule. We evaluated two methods to measure Hb concentration among individuals with and without Hb variants using a hemoglobinometer (HemoCue®) and a hematology analyzer (Sysmex XT-1800i). MethodsWe determined the bias and concordance between the methods among 420 Cambodian women (18–45y). ResultsBias and concordance appeared similar between methods among women with no Hb disorders (n=195, bias=2.5, ρc=0.68), women with Hb E variants (n=133, bias=2.5, ρc=0.78), and women with other Hb variants (n=92, bias=2.7, ρc=0.73). The overall bias was 2.6g/l, resulting in a difference in anemia prevalence of 11.5% (41% using HemoCue® and 29.5% using Sysmex, p<0.001). Based on visual interpretation of the concordance plots, the HemoCue® device appears to underestimate Hb concentrations at lower Hb concentrations and to overestimate Hb concentrations at higher Hb concentrations (in comparison to the Sysmex analyzer). ConclusionsBias and concordance were similar across groups, suggesting the two methods of Hb measurement were comparable. We caution field staff, researchers and policy makers in the interpretation of data and the impact that bias between methods can have on anemia prevalence rates.

Iron-Containing Micronutrient Supplementation of Chinese Women with No or Mild Anemia during Pregnancy Improved Iron Status but Did Not Affect Perinatal Anemia

Universal prenatal daily iron–folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron status [serum ferritin (SF), serum soluble transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a randomized, double-blind trial in China. Women were randomly assigned to take daily 400 μ g of folic acid (FA) (control), FA plus 30 mg of iron, or FA, iron, plus 13 additional MMs provided before 20 wk of gestation to delivery. Venous blood was collected in this subset during study enrollment (before 20 wk of gestation) and 28–32 wk of gestation. We found that, at 28–32 wk of gestation, compared with the FA group, both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28–32 wk of gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% by using low SF, 53.6%, 59.9%, and 69.9% by using high sTfR, and 34.5%, 41.2%, and 59.6% by using low BI, respectively. However, there was no difference in anemia prevalence (hemoglobin < 110 g/L) between FA and IFA or MM groups. We concluded that, compared with FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia. This trial was registered at clinicaltrials.gov>as NCT00137744.

Anemia Prevalence in a Home Visit Geriatric Population

Ascertain anemia prevalence in the home visit geriatric population. Retrospective chart review. A geriatric home visit program of a community-based teaching hospital. Non-institutionalized elderly patients referred to the geriatric home visit program from March 1, 2003, through October 1, 2006. Demographic, diagnostic, and hemoglobin data were abstracted. Anemia was defined using the WHO criteria of hemoglobin (Hb) less than 13 g/dL in men and less than 12 g/dL in women. The cohort consisted of 244 patients, predominantly white (88%), women (77%), and with a median age of 85 years. Anemia prevalence was 39.6% (95% CI: 32.6-46.9): 44.7% (95% CI: 30.2-59.9) in the men and 37.9% (95% CI: 30.0-46.4%) in the women. There was no statistically significant difference in anemia prevalence by race, known diagnosis of dementia, or by any other comorbidity. Majorities (86.8%) of the anemias were normocytic, 10.5% were microcytic, and 2.6% had macrocytosis. About 36.4% had nutrient deficiencies, 13.6% had anemia of chronic disease, 9.1% had myelodysplastic syndrome, and the etiology remained unknown for 40.9%. Anemia prevalence in the homebound geriatric population is high, about 4 times the National Health and Nutrition Examination Survey (NHANES III) estimate for the free-living, community-dwelling elderly. It mirrors the high prevalence in the nursing home population.

Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia

To evaluate effects of Fe supplementation and sex on the prevalence of anaemia and Fe status in infants in South-East Asia, biochemical data from four parallel, randomized, double-blind trials with Fe and/or Zn supplementation in infants (n 2452) in Indonesia, Thailand and Vietnam was pooled. At recruitment (5 months of age), Hb concentrations were slightly but significantly lower in boy infants compared with girl infants (108.7 g/l v. 111.4 g/l, P = 0.04). At 11 months of age, boy infants not receiving Fe had significantly lower Hb (106.2 g/l v. 111.0 g/l, P < 0.001) and lower serum ferritin concentrations (14.3 microg/l v. 21.1 g/l, P < 0.001) than girl infants not receiving Fe. Consequently, boy infants had a relative risk of 1.6 (95% CI 1.3, 2.1) to be anaemic, and of 3.3 (95% CI 2.1, 5.0) for having Fe deficiency anaemia compared with girl infants. Fe supplementation significantly increased Hb concentrations in both boys and girls. There was no sex difference in Fe status in infants receiving Fe for 6 months. This study shows that the markedly higher risk for anaemia and Fe deficiency indicates higher Fe requirements in boy than in girl infants. In South-East Asia, standard infant feeding practices do not provide sufficient Fe to meet requirements of infants, especially boys. Current daily recommended intake for Fe in infancy is the same for boy and girl infants however. Our findings suggest that in especially the second half of infancy, Fe requirements for boy infants are approximately 0.9 mg/d higher than for girl infants.